Form D Raw Data - Electronic Filing Depository

EFDID: 375190EFD: Raw Data

Issuer: Polysign, Inc. (0001722286) - D

Accession: 0001722286-21-000002 () (EDGAR Files) (Form D)

Edgar Posted: May. 14, 2021
EFD Posted: May. 17, 2021

- < edgarSubmission >

< schemaVersion > X0708 </ schemaVersion >

< submissionType > D </ submissionType >

< testOrLive > LIVE </ testOrLive >

- < primaryIssuer >

< cik > 0001722286 </ cik >

< entityName > Polysign, Inc. </ entityName >

- < issuerAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > OAKLAND </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ issuerAddress >

< issuerPhoneNumber > 510-596-1754 </ issuerPhoneNumber >

< jurisdictionOfInc > CALIFORNIA </ jurisdictionOfInc >

- < issuerPreviousNameList >

< value > None </ value >

</ issuerPreviousNameList >

- < edgarPreviousNameList >

< value > None </ value >

</ edgarPreviousNameList >

< entityType > Corporation </ entityType >

- < yearOfInc >

< withinFiveYears > true </ withinFiveYears >

< value > 2017 </ value >

</ yearOfInc >

</ primaryIssuer >

- < relatedPersonsList >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Arthur </ firstName >

< lastName > Britto, II </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Jack </ firstName >

< lastName > McDonald </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > David </ firstName >

< lastName > Schwartz </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Timothy </ firstName >

< middleName > F. </ middleName >

< lastName > Keaney </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Dan </ firstName >

< lastName > Charney </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Ding </ firstName >

< lastName > Chun </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Cherie </ firstName >

< middleName > G. </ middleName >

< lastName > Porter </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Fred </ firstName >

< lastName > Wagner </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > John </ firstName >

< lastName > Holmes </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 1300 Clay Street, Suite 600 </ street1 >

< city > Oakland </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 94612 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

</ relatedPersonsList >

- < offeringData >

- < industryGroup >

< industryGroupType > Other Technology </ industryGroupType >

</ industryGroup >

- < issuerSize >

< revenueRange > Decline to Disclose </ revenueRange >

</ issuerSize >

- < federalExemptionsExclusions >

< item > 06b </ item >

</ federalExemptionsExclusions >

- < typeOfFiling >

- < newOrAmendment >

< isAmendment > false </ isAmendment >

</ newOrAmendment >

- < dateOfFirstSale >

< value > 2021-05-12 </ value >

</ dateOfFirstSale >

</ typeOfFiling >

- < durationOfOffering >

< moreThanOneYear > false </ moreThanOneYear >

</ durationOfOffering >

- < typesOfSecuritiesOffered >

< isEquityType > true </ isEquityType >

</ typesOfSecuritiesOffered >

- < businessCombinationTransaction >

< isBusinessCombinationTransaction > false </ isBusinessCombinationTransaction >

< clarificationOfResponse />

</ businessCombinationTransaction >

< minimumInvestmentAccepted > 0 </ minimumInvestmentAccepted >

- < salesCompensationList >

- < recipient >

< recipientName > N/A </ recipientName >

< recipientCRDNumber > None </ recipientCRDNumber >

< associatedBDName > Macquarie Capital (USA) Inc. </ associatedBDName >

< associatedBDCRDNumber > 36368 </ associatedBDCRDNumber >

- < recipientAddress >

< street1 > 125 West 55th Street Level 22 </ street1 >

< city > New York </ city >

< stateOrCountry > NY </ stateOrCountry >

< stateOrCountryDescription > NEW YORK </ stateOrCountryDescription >

< zipCode > 10019 </ zipCode >

</ recipientAddress >

- < statesOfSolicitationList >

< state > CA </ state >

< description > CALIFORNIA </ description >

< state > NV </ state >

< description > NEVADA </ description >

< state > NY </ state >

< description > NEW YORK </ description >

</ statesOfSolicitationList >

< foreignSolicitation > false </ foreignSolicitation >

</ recipient >

</ salesCompensationList >

- < offeringSalesAmounts >

< totalOfferingAmount > 60000000 </ totalOfferingAmount >

< totalAmountSold > 53111198 </ totalAmountSold >

< totalRemaining > 6888802 </ totalRemaining >

< clarificationOfResponse />

</ offeringSalesAmounts >

- < investors >

< hasNonAccreditedInvestors > false </ hasNonAccreditedInvestors >

< totalNumberAlreadyInvested > 5 </ totalNumberAlreadyInvested >

</ investors >

- < salesCommissionsFindersFees >

- < salesCommissions >

< dollarAmount > 3000000 </ dollarAmount >

< isEstimate > true </ isEstimate >

</ salesCommissions >

- < findersFees >

< dollarAmount > 0 </ dollarAmount >

</ findersFees >

< clarificationOfResponse > Subject to additional closing(s) </ clarificationOfResponse >

</ salesCommissionsFindersFees >

- < useOfProceeds >

- < grossProceedsUsed >

< dollarAmount > 0 </ dollarAmount >

</ grossProceedsUsed >

< clarificationOfResponse />

</ useOfProceeds >

- < signatureBlock >

< authorizedRepresentative > false </ authorizedRepresentative >

- < signature >

< issuerName > Polysign, Inc. </ issuerName >

< signatureName > Cherie G. Porter </ signatureName >

< nameOfSigner > Cherie G. Porter </ nameOfSigner >

< signatureTitle > Secretary and General Counsel </ signatureTitle >

< signatureDate > 2021-05-14 </ signatureDate >

</ signature >

</ signatureBlock >

</ offeringData >

</ edgarSubmission >